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. 2018 Dec 7;1(8):e185937.
doi: 10.1001/jamanetworkopen.2018.5937.

Comparison of Nicotine and Toxicant Exposure in Users of Electronic Cigarettes and Combustible Cigarettes

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Free PMC article

Comparison of Nicotine and Toxicant Exposure in Users of Electronic Cigarettes and Combustible Cigarettes

Maciej L Goniewicz et al. JAMA Netw Open. .
Free PMC article

Abstract

Importance: Use of electronic cigarettes (e-cigarettes) is increasing. Measures of exposure to known tobacco-related toxicants among e-cigarette users will inform potential health risks to individual product users.

Objectives: To estimate concentrations of tobacco-related toxicants among e-cigarette users and compare these biomarker concentrations with those observed in combustible cigarette users, dual users, and never tobacco users.

Design, setting, and participants: A population-based, longitudinal cohort study was conducted in the United States in 2013-2014. Cross-sectional analysis was performed between November 4, 2016, and October 5, 2017, of biomarkers of exposure to tobacco-related toxicants collected by the Population Assessment of Tobacco and Health Study. Participants included adults who provided a urine sample and data on tobacco use (N = 5105).

Exposures: The primary exposure was tobacco use, including current exclusive e-cigarette users (n = 247), current exclusive cigarette smokers (n = 2411), and users of both products (dual users) (n = 792) compared with never tobacco users (n = 1655).

Main outcomes and measures: Geometric mean concentrations of 50 individual biomarkers from 5 major classes of tobacco product constituents were measured: nicotine, tobacco-specific nitrosamines (TSNAs), metals, polycyclic aromatic hydrocarbons (PAHs), and volatile organic compounds (VOCs).

Results: Of the 5105 participants, most were aged 35 to 54 years (weighted percentage, 38%; 95% CI, 35%-40%), women (60%; 95% CI, 59%-62%), and non-Hispanic white (61%; 95% CI, 58%-64%). Compared with exclusive e-cigarette users, never users had 19% to 81% significantly lower concentrations of biomarkers of exposure to nicotine, TSNAs, some metals (eg, cadmium and lead), and some VOCs (including acrylonitrile). Exclusive e-cigarette users showed 10% to 98% significantly lower concentrations of biomarkers of exposure, including TSNAs, PAHs, most VOCs, and nicotine, compared with exclusive cigarette smokers; concentrations were comparable for metals and 3 VOCs. Exclusive cigarette users showed 10% to 36% lower concentrations of several biomarkers than dual users. Frequency of cigarette use among dual users was positively correlated with nicotine and toxicant exposure.

Conclusions and relevance: Exclusive use of e-cigarettes appears to result in measurable exposure to known tobacco-related toxicants, generally at lower levels than cigarette smoking. Toxicant exposure is greatest among dual users, and frequency of combustible cigarette use is positively correlated with tobacco toxicant concentration. These findings provide evidence that using combusted tobacco cigarettes alone or in combination with e-cigarettes is associated with higher concentrations of potentially harmful tobacco constituents in comparison with using e-cigarettes alone.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Goniewicz receives fees for serving on an advisory board from Johnson & Johnson and grant support from Pfizer. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Biomarkers of Exposure Among Dual Users, Cigarette-Only Smokers, e-Cigarette–Only Users, and Never Users, Population Assessment of Tobacco and Health Study, Wave 1, 2013-2014 (N = 5105)
Exposure to nicotine (TNE2) (A), tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) (B), lead (C), cadmium (D), naphthalene (2-naphthol) (2-NAP) (E), pyrene (1-hydroxypyrene) (1-PYR) (F), acrylonitrile (CYMA) (G), acrolein (CEMA) (H), and acrylamide (AAMA) (I). All analyses are weighted. Some volatile organic compound laboratory results were outstanding at the time these analyses were conducted, so weighted estimates may not accurately reflect values in the target population. Box depicts median (interquartile range); whiskers depict minimum and maximum values for creatinine level–corrected biomarker values across tobacco user groups. Outliers excluded from figure to facilitate presentation clarity. aStatistically significant difference from never users adjusted for urinary creatinine level, cigarettes per day, age, sex, race/ethnicity, educational level, secondhand smoke exposure, past 30-day marijuana use, and tobacco use status. bStatistically significant difference cigarette-only users adjusted for urinary creatinine level, cigarettes per day, age, sex, race/ethnicity, educational level, secondhand smoke exposure, past 30-day marijuana use.
Figure 2.
Figure 2.. Biomarkers of Exposure Among e-Cigarette–Only Users and Cigarette-Only Smokers, Stratified by Everyday or Some-Days Product Use, Population Assessment of Tobacco and Health Study, Wave 1, 2013-2014 (n = 2658)
Exposure to nicotine (TNE2) (A), tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) (B), lead (C), cadmium (D), naphthalene (2-naphthol) (2-NAP) (E), pyrene (1-hydroxypyrene) (1-PYR) (F), acrylonitrile (CYMA) (G), acrolein (CEMA) (H), and acrylamide (AAMA) (I). All analyses are weighted. Some volatile organic compound laboratory results were outstanding at the time these analyses were conducted, so weighted estimates may not accurately reflect values in the target population. Everyday e-cigarette users reported yes to current daily use of e-cigarettes, no to current everyday/some-day use of all other tobacco products; some-days e-cigarette users reported yes to current some-days use of e-cigarettes, no to current everyday/some-days use of all other tobacco products; everyday smokers reported yes to current daily use of cigarettes, no to current everyday/some-days use of all other tobacco product; some-days smokers reported yes to current some days use of cigarettes, no to current everyday/some-days use of all other tobacco products. All user groups reported no past 3-day use of nicotine replacement therapies. Box depicts median (interquartile range); whiskers depict minimum and maximum values for creatinine-corrected biomarker across tobacco user groups. Outliers excluded from figure to facilitate presentation clarity. aStatistically significant difference with everyday e-cigarette users based on results from adjusted linear regression models (P < .05). Comparisons were performed for everyday smokers with everyday e-cigarette users, everyday smokers with some-days smokers, everyday e-cigarette users with some-days smokers, and everyday e-cigarette users with some-days e-cigarette users. bStatistically significant difference with everyday smokers based on results from adjusted linear regression models (P < .05).
Figure 3.
Figure 3.. Biomarkers of Exposure Among Dual Users of Tobacco Cigarettes and e-Cigarettes, Population Assessment of Tobacco and Health Study, Wave 1, 2013-2014 (n = 792)
Exposure to nicotine (TNE2) (A), tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) (B), lead (C), cadmium (D), naphthalene (2-naphthol) (2-NAP) (E), pyrene (1-hydroxypyrene) (1-PYR) (F), acrylonitrile (CYMA) (G), acrolein (CEMA) (H), and acrylamide (AAMA) (I). All analyses are weighted. Some volatile organic compound laboratory results were outstanding at the time these analyses were conducted, so weighted estimates may not accurately reflect values in the target population. Mean number of cigarettes per day (CPD) in everyday smokers/everyday e-cigarette users was 15.9 (95% CI 13.8-18.1); some days smokers/everyday e-cigarette users, 14.3 CPD (on days smoked) (95% CI 4.6-24.0 CPD); everyday smokers/some-days e-cigarette users, 16.2 CPD (95% CI, 15.5-16.9); and some-days smokers/some-days e-cigarette users, 6.1 CPD (on days smoked) (95% CI, 4.2-8.0 CPD). Box depicts median and interquartile range; whiskers depict minimum and maximum values for creatinine level–corrected biomarker values across tobacco user groups. Outliers excluded from figure to facilitate presentation clarity. aDenotes estimate with relative SE greater than 30%. bStatistically significant difference from everyday smokers/some days e-cigarette users adjusted for urinary creatinine level, CPD, age, sex, race/ethnicity, educational level, secondhand smoke exposure, and past 30-day marijuana use. cStatistically significant difference from everyday smokers/everyday e-cigarette users adjusted for urinary creatinine level, CPD, age, sex, race/ethnicity, educational level, secondhand smoke exposure, past 30-day marijuana use, and tobacco use status.

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